How optimal is the medical treatment used in patients with low ejection fraction heart failure "epidemiological study"

Introductıon and aim: Studies have shown that in order to obtain optimal benefit from beta blockers, ACE inhibitors and mineralocorticoid receptor blockers, which are used in the medical treatment of heart failure and have been proven to prolong life, it is not sufficient to reduce mortality, and that the dose they are used is of great importance. Current Heart Failure treatment guidelines emphasized the importance of this situation and stated that the target doses should be reached in order to obtain maximum benefit. Despite the guideline recommendations, there are publications that the preferred treatment doses in clinical practice remain below the recommended dose. The aim of our study is to investigate the medical treatment and doses used in patients treated with a diagnosis of heart failure, and whether these vital drugs are used at the required dose by cardiology physicians in patients with indication, by making a survey. In order to understand why the dose is kept low in patients who are not used at the appropriate dose, it is aimed to find the reasons, if any, and to discuss what can be done to increase the optimal dose use rate. Material and method: Our study is a single center survey study. In our study, 419 patients over the age of 18 years with EF<%40 who were followed up and treated with the diagnosis of heart failure in the Dicle University Medical Faculty Cardiology policlinic were included. Demographic and socioeconomic data of the patients were recorded. It was questioned whether the patients used heart failure drugs, the dosage of drugs, if the patients were not using drugs, they were asked why they did not use them. Routine hematological and biochemical parameters studied during the follow-up of the patient were recorded. Systolic and diastolic diameters, EF and other basic echocardiographic parameters were measured by 2D Transthoracic Echocardiography. Findings: 419 HFrEF patients were included in the study. %65.5 (275) of 419 patients were male and %34.5 (144) were female. The mean age was 65.2 ± 13.8. %55.6 (233) of the causes of heart failure in the patients were ischemic heart disease and %33.9 (142) were dilated CMP. %56.7 of the patients had HT (238), %52 (218) had CAD, %23.2 (97) had HPL, %36.4 (153) had DM, %19.6 (82) had additional diseases such as CKD. %48 (201) of the patients had a history of smoking. Periods of heart failure was in %27.2 (114) 6-10 years, %19.3 (81) 4-5 years, %18.9 (79) 3 years, %18.4 (77) 2 years, %14.1 (59) 1 year, %2.1 ( 9) > 10 years. The mean systolic pressure of the patients was 120.4 ± 10.5, the mean diastolic pressure was 74.1 ± 7.9. %51.9 (217) of the patients had NYHA 1, %44 (184) NYHA 2, %4.1 (17) NYHA 3 functional capacity. %45.2 of the patients (188) had a history of hospitalizations once, %7 (29) 2-3 times, %2.9 (12) had more than 3 hospitalizations. The mean heart rate was 75.4 ± 8.8. %74 (310) of the patients were in sinus rhythm, %26 (109) in AF rhythm. %24.8 (104) had LBBB, and %2.9 (12) had RBBB. The average EF of the patients was %31.9 ± 6.7. In the admission echocardiographies of the patients, %41.6 had 2nd degree and above mitral valve regurgitation , %2.9 had 2nd degree and above aortic valve regurgitation, %28.6 had 2nd degree and above tricuspid valve regurgitation. Of the 419 patients in our study, %99.3 (416) were using BB, %91.1 (382) were using ACEI / ARB, %67.7 were using MRA and %93 were using non-MRA diuretics. The proportion of ASA users was %45.6 (191), digoxin %12.9 (54), ivabradine %4.1 (17), valsartan + sacubitril %1.9 (7), OAC %29.1 (122), statin %17.3 (72). Of the patients, %16.7 (70) had ICD, %8.1 (34) ICD-CRT, %0.2 (1) had LVAD. %47.4 (197) of the patients using beta blockers were using metoprolol, %40.9 (170) were using carvedilol. The proportion of those who received the maximal dose of beta blockers was %7.5 (31). %67.6 (211) of the patients using ACEI were using ramipril, %25 (78) of them were using perindopril and %5.5 (17) of them were using zofenopril. The number of patients using the maximum dose of ACEI was 52. For the ARB group, %57.7 (41) of the patients were using valsartan and %31 (22) were using candesartan. The number of people who received the maximum dose of ARB was 1 (valsartan). The rate of patients using MRA treatment was %67.7 (283 patients). %90 of them were spiranolactone (256) and %9.5 (27) were eplerenone. The number of people using MRA at the maximum dose was 15. All were patients using spiranolactone. It was questioned why our patients with HFrEF did not take "BB, ACEI / ARB, MRA" agents, which are the main treatments, at the maximal doses recommended by the guidelines. The most common reason was "not recommended by the physician" (%49.6 for BB, %44.6 for ADEI / ARB, %38.7 for MRA). Conclusion: In our study, it was found that the use of heart failure drugs recommended by the guidelines at the optimal dose was very low. It was observed that the main reason for the patients who did not / could not receive medical treatment at the optimal dose was "not recommended by the physician" and the second most common reason was the "non-attendance of the patient with socioeconomic reasons". Keywords: Heart failure with reduced ejection fraction, medical therapy optimization